Migraines

Question 1

Epidemiology of migraines

Answer 1

3 times more common in women

Question 2

Common triggers for a migraine attack

Answer 2

tiredness, stress
alcohol
combined oral contraceptive pill
lack of food or dehydration
cheese, chocolate, red wines, citrus fruits
menstruation
bright lights

Question 3

Migraine diagnostic criteria

Answer 3

At least 5 attacks fulfilling criteria B-D

• Headache attacks lasting 4-72 hours*

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Headache has at least two of the following characteristics:

1. unilateral location
   in children, attacks may be shorter-lasting, headache is more commonly bilateral, and gastrointestinal disturbance is more prominent.
2. pulsating quality (i.e., varying with the heartbeat)
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)

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During headache at least one of the following:
1. nausea and/or vomiting*
2. photophobia and phonophobia

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Not attributed to another disorder

Question 4

X

Question 5

X

Question 6

X

Question 7

X

Question 8

X

Question 9

X

Question 10

X

Question 11

X

Question 12

C

Question 13

X

Question 14

C

Question 15

X

Question 16

X

Question 17

X

Question 18

C

Question 19

C

Question 20

C

Question 21

C

Question 22

Cx

Question 23

C

Question 24

C

Question 25

Hemiplegic migraine characteristic

Answer 25

motor weakness is a manifestation of aura in at least some attacks

Question 26

Risk factors for hemiplegic migraines a

Answer 26

a strong family history

Question 27

migraine with brainstem aura (basilar-type migraine, or Bickerstaff’s Syndrome)

Answer 27

gradual onset over ten minutes, and step-wise progression of symptoms point

Dysarthria
Vertigo
Diplopia
Temporary decreased consciousness - syncope
Pins and needles of both arms

Question 28

x

Question 29

x

Question 30

x

Question 31

x

Question 32

x

Question 33

x

Question 34

ACUTE Migraine management attacks ?

Answer 34

oral triptan and an NSAID, or
an oral triptan and paracetamol

oung people aged 12-17 years consider a nasal triptan

Question 35

if first line management not effective ?

Answer 35

NON oral preparation of metoclopramide or prochlorperazine

a non-oral NSAID or triptan

Question 36

x

Question 37

what is used as a migraine prophylaxis ?

Answer 37

propranolol

topiramate - avoided in pregnancy / can reduce the effectiveness of hormonal contraceptives

amitriptyline

Question 38

if first line managing of migraine prophylaxis fail ?

Answer 38

10 sessions of acupuncture over 5-8 weeks

riboflavin (400 mg once a day)

Question 39

migrane pophylaxis women with predictable menstrual migraine

Answer 39

frovatriptan (2.5 mg twice a day) or zolmitriptan (2.5 mg twice or three times a day) as a type of ‘mini-prophylaxis’

Question 40

Migraine during pregnancy first line ?

Answer 40

paracetamol 1g is first-line
NSAIDs can be used second-line in the first and second trimester

Question 41

what is needed to be avoided in pregnancy ?

Answer 41

avoid aspirin and opioids such as codeine during pregnancy

Question 42

if patients have migraine with aura what is contraindicated ?

Answer 42

combined oral contraceptive (COC) pill - increase risk of stroke

Question 43

hormone replacement therapy (HRT) safe to prescribe fro migraines ?

Answer 43

hormone replacement therapy (HRT)

Question 44

migraine with menstruation ?

Answer 44

mefanamic acid
or a combination of aspirin, paracetamol and caffeine